In any given week, 81 percent of adults in the U.S. are taking at least one medication, from insulin to Ritalin, from blood pressure pills to Prozac (according to the 2005 Boston University Slone Epidemiology Center survey on the patterns of medication use in the United States).
Given that staggering number, it's obvious that a sizable percentage of the people in our congregations are on medications, some of which are mood altering or psychotic behavior stabilizers.
Does this change the way we counsel? Does this change the way we preach?
A Series of Unfortunate Events
Something was really different about "Tammy," one of our church's regular attenders. She had a hard time making eye contact. She was disheveled and unkempt. She talked in an agitated and staccato pattern, as if she already knew you weren't listening and assumed you didn't care. She had obviously been hurt, scarred, or violated, and her tone told me she didn't trust authority or believe I could possibly be sincere.
I slowly pieced together her story through conversations with other women in the church. As the years passed and her church relationships grew, Tammy began to blend in as one of our own. She developed some close friendships, and she often stopped by the church office to talk with me and to pray.
Then about a year ago, and for a period of about six months, her life turned tragic. Every week there was a new development: She told us she had developed a liver disease that led to hospitalizations and the medical staff had shaved her head; the death of a close family member produced traumatic grief; she reported a clandestine relationship that turned from romantic to violent; she had wild and crazy phone conversations in my presence with people I'd never heard of. Those ministering to her tried to love and nurture Tammy through all these dramatic episodes, but we were all overwhelmed.
Her story of the death of a second family member sounded too strange to be true. It was.
With a little research, we found all her histrionics were based on lies. Even the phone calls were faked. When we confronted her with the truth, she didn't fight us. She was defeated and broken and agreed to take steps toward recovery and mental health.
Tammy signed the release forms and agreed for us to discuss her mental health issues with past therapists and caseworkers.
What we discovered in those conversations was that Tammy's story, like her illness, was many layers deep. The eye-opener was that Tammy had been off her medication for the last six months and had slipped back into psychotic episodes familiar to her former counselors and well-documented in her records.
We loved Tammy as best we could, in ways we thought Jesus would, but we could have served her better by recognizing her medical issues earlier.
Off Their Meds
I am an experienced therapist who specialized in crisis work, and still I was blind to some obvious signs that Tammy was off her meds. I should have noticed some of the changes, but I think I was caught up in the day-to-day spiritual and relational issues and missed the bigger picture. In review, here are some signs that people are having meds issues—either they need meds, or are off them:
Creating a Safe Place
How common is this in church life? Do people who struggle with interpersonal relationships and exhibit strange behaviors actually need to be on some kind of medication? As pastors, how can we find out this kind of information? After we do, who do we tell?
Key to addressing this issue is creating an environment where it's okay to admit you have medication and mental health issues. I am now communicating with our congregation in a similar way I did with the staff and students at the college campus. Mental health is a reality, and so is mental illness. We all know people with phobias and disorders. In fact, we are those people.
I try to reduce the stigma by referring to standard mental health issues like depression and addiction in my messages. I use dramatic stories I've read as introductions or illustrations. And I try to communicate that mental health issues are not spiritual failings. God heals in many ways, including regular, carefully regulated doses of mood stabilizing drugs. And God can use these conditions to draw people closer to himself.
For some people in our congregation, such as those who ministered to Tammy through an accountability group, mental health is a ministry field. I don't reveal names or imply that we have such cases in our church, but occasional references to mental and emotional wellbeing are encouraging to the hurting and to those trying to help them.
Counseling Mental Illness
More important is how we handle mental health issues in our office, specifically when dealing with parishioners who come in for counseling. In most of my pastoral counseling appointments, I ask about medication history and current medications as a routine part of the intake process (see "Probing Questions" on p. 11).
This may seem intrusive, but most people are very comfortable with this line of questioning these days. If they aren't, I simply move on. Some folks still feel guilty about taking medication for what they perceive to be "a spiritual issue," but at least they know I'm open to discussing medications in the future. Because I raised the issue initially, they may feel free to bring it up later.
If they answer the medical questions, I take the time to research the condition on the Internet, learning what each medication does and its side effects. Sometimes I call mental health professionals to ask how to deal appropriately with someone using that kind of medication. I don't reveal names or specifics, just ask for some basic guidelines.
Once I know more, I follow up by giving the counselee tools for better self-awareness and accountability. And I encourage the counselee to reveal the condition to at least one other trusted person in the congregation. The pastor should not be the only one who knows.
I give the counselee a copy of the information I gathered. If appropriate, I will challenge him or her to get involved with a small group that deals with such issues—whether that is available at our church or another church in town. In Tammy's case accountability has proven to be life altering. Although she now lives in a different city, she stopped by last week to visit. She is doing much better, she says, and her mood and behavior have stabilized. It was good to see her smile and to hear her laugh. It was encouraging to know that she has received help and that she is seeing her counselor and doctor as prescribed.
Wait a minute … I have a phone call. It's one of Tammy's accountability partners. Tammy's counselor just called and said Tammy skipped her appointment again. The partner wanted me to know she would be confronting Tammy. It's good to know that the system we worked hard to get in place is helping us care for one of God's children.
—ELLIOTT ANDERSON is senior pastor of Elgin Evangelical Free Church in Elgin, Illinois; adapted from our sister publication Leadership Journal, © 2007 Christianity Today. For more articles like this, visit www.LeadershipJournal.net.
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